Tag: American Academy of Pediatrics

(CNN) — Parenting is not for the faint of heart. It can take new parents a beat or two to fully tune in to what their baby’s cries could mean. So many small but consequential decisions need to be made on a daily, if not hourly, basis. There are also questions. Many questions.

At a time when misinformation abounds, pediatrician Dr. David Hill is the calm voice of reassurance and reason, grounded in science. He encourages new parents to ask their baby’s pediatrician questions, including about any advice they find on the internet.

“People come to me with stuff all the time,” Hill said, noting the importance of forging a solid parent-pediatrician relationship. That trust, he said, is what’s “going to steer us through this swamp of misinformation and disinformation that’s out there right now.”

Hill is a father of five in a blended family who has been in practice for more than 25 years. He has been the associate medical editor of the American Academy of Pediatrics’ book “Caring for Your Baby and Young Child: Birth to Age 5, 8th edition,” and is slated to be the editor-in-chief for the next edition. He also cohosts the academy’s podcast “Pediatrics On Call.”

“The question I get the most often from new parents, and even those who have been at it for a while is, is this normal?” Hill told CNN Chief Medical Correspondent Dr. Sanjay Gupta recently on his podcast, Chasing Life.

“As somebody who’s seen probably over 10,000 children … it is a joy for me to almost always be able to reassure, and be like, ‘Yeah. That’s fine. They do that. Kids do a lot of weird things, and they do a lot of things at their own pace,” Hill said. “Normal can be all over the map.”

You can listen to the podcast’s full episode here.

Hill said he strongly urges parents to seek out trusted, reliable sources for guidance. “Sources of information that have been validated, that use real data,” he said. “And honestly, talk to your child’s doctor — develop that relationship, because that’s what we’ve dedicated our lives to doing.”

Hill works closely with the AAP on the organization’s parent-facing information. “I do that because I know, over decades of experience, how dedicated everybody in that group is to making sure we get this right, including being willing to get egg on our faces and say, ‘You know what? We were wrong,’ when we were wrong,” Hill said. “And that’s really critical. Anybody who’s never wrong, I don’t trust, because none of us is perfect.”

During the decades Hill has been in practice, he has witnessed some of the babies he saw at the start of his career become parents themselves. During that time, he has also watched the science of child health evolve.

“What I tell these new parents is sometimes the complete opposite of what I said when they were babies!” he said via email.

Here are the five biggest changes Hill has seen over his career.

Safe sleep practices

Sleep guidelines literally flipped in 1994, when Hill finished medical school. That year, the National Institute of Child Health and Human Development launched the first “Back to Sleep” campaign urging parents to put their baby to sleep on their back. Before then, parents had been told to put an infant to sleep on the belly to avoid aspiration.

But that’s not all. The US Consumer Product Safety Commission banned drop-side cribs from the marketplace in 2011 and warned against inclined sleepers in 2019, Hill said. And the Safe Sleep for Babies Act, signed into federal law in 2022, outright banned the sale of drop-side cribs and crib bumpers that could potentially suffocate infants.

He noted that in 1990, there were 154 sudden unexpected infant deaths per 100,000 babies, a number that fell 44% to a low of 86 in 2011. (It has since gone up to 100 deaths per 100,000 in 2022).

“While some of those deaths are from mysterious or unavoidable causes,” he said, “many could still be prevented by following all the safe sleep guidelines, including not only placing infants on their backs to sleep, but never co-sleeping (and) avoiding soft bedding.”

Advice to prevent food allergies

Complete avoidance is out, and small exposures are in.

“I still remember in 2015 searching all the drawers in our practice for outdated infant feeding handouts that, if parents followed them, could put their babies at increased risk of developing life-threatening food allergies,” Hill said. “These handouts told parents to avoid giving their infants and toddlers anything containing peanuts or eggs until they turned at least 2 years old, even 3 if they had eczema or a family history of allergies.”

But, Hill said, in 2015, the results of the LEAP trial confirmed what some earlier studies had suggested: “That it wasn’t early peanut exposure that had caused a doubling of peanut allergies in the preceding decade. It was the advice in these handouts!” he said.

Now parents and guardians are advised to introduce peanut-containing products and eggs along with other solid foods in the first year of life, as soon as babies are safely taking solids, usually around 6 months of age.

Preventing babies from having any exposure to potential allergens apparently left their immune systems oversensitive when they finally did encounter them later on.

Umbilical cord care

Umbilical cords used to be treated with a messy (for doctors) purple “triple” dye — an antiseptic to keep bacterial infections at bay. Now, the recommendation in well-resourced countries and communities is to let the cord dry on its own — and to keep a close eye on it.

“The purpose of the dye was to prevent potentially dangerous infections of the umbilical cord and surrounding tissues (omphalitis),” Hill said. “Then, a few brave souls, perhaps fed up with their dry-cleaning bills, decided to see what would happen if we used alcohol instead of the dye. It turned out … nothing.”

Hill said the next step was to just let the cord dry on its own, taking care not to trap it in a wet or soiled diaper for extended periods and to avoid soaking it at bathtime. That practice is where the guidance stands today.

Some known risk factors for omphalitis, Hill said, include low birth weight, prolonged rupture of membranes or prolonged labor, maternal infection, nonsterile delivery or home birth, and improper cord care.

“If you see the skin around the belly button turning red or notice an unusually foul discharge, get your baby seen,” he advised.

What about bathing? Should new parents avoid baths until the cord falls off? “Advice on this one varies, but it’s not clear there’s any more danger from a brief immersion than from a sponge bath,” he said.

New and better vaccines

The vaccination schedule for infants and children has been updated throughout the years as new shots become available, offering better protection against childhood scourges.

“My dad is also a pediatrician, and I grew up hearing horror stories of babies suffering from meningitis and sepsis. It seems my dad was always dashing off to the hospital to perform spinal taps,” Hill recalled. “This started to change, however, in 1985, when a vaccine against Haemophilus influenza B, one of the most dreaded infections of childhood, came out.

“In training and early in my career, I saw awful infections from another bacteria, pneumococcal pneumonia. These infections became much rarer in 2000, when the first pneumococcal vaccine for children came out,” he said. “Since then, that vaccine has expanded from covering seven subtypes of pneumococcus to covering as many as 23.”

Just in the past year, Hill said he witnessed another infantile infection he dreaded, RSV, or respiratory syncytial virus, plummet in frequency and severity thanks to both vaccines for expectant mothers and antibody injections for babies.

Considering the big picture

Another change involves a paradigm shift in the way pediatricians think about health and well-being, Hill said.

“In pediatrics, one of those tectonic shifts hit in 1998, the year I started practice and the year the ACEs Study came out,” he said, referring to a study that looked at adverse childhood experiences. Those potentially traumatic events include physical, emotional and/or sexual abuse; the death of a parent; mental illness; or violence or substance abuse in the household, any of which can create toxic stress in a child, leading to changes in brain development and affecting future mental, physical and emotional health.

“Many people had noticed that traumatic events in childhood … seemed to impact later health,” Hill said. “The ACEs Study measured and quantified the extent and duration of these effects, and the results were more dramatic and longer-lasting than anyone had guessed.”

An explosion of research followed, Hill said, which led to a new approach in pediatrics.

“Every child faces stressful events, some severe enough to impact their health. But the safe, stable, nurturing relationships that children build with the adults around them can protect them,” he explained. “Understanding these interactions inspires trauma-informed care, an effort to work with families to address the stresses in their lives and to build those emotional connections that can help their children thrive.”

Under this approach, Hill said, pediatricians pivoted from asking “What’s wrong with you?” to asking “What happened to you, and how can we help?”

“A key concept here is the ‘good enough parent,’” he said. “No parent is perfect, but perfection is not required to be safe, stable, and nurturing.”

As a parent himself, Hill said that thought “brings me a sigh of relief.”

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